Approach to Suspected Physeal Fractures in the Emergency Department

Growth plate (physeal) fractures are defined as a disruption in the cartilaginous physis of bone with or without the involvement of epiphysis or metaphysis. These represent around 15-18% of all pediatric fractures. It is important to diagnose physeal injury as early as possible, as misdiagnosis or delay in diagnosis may result in long term complications. Physeal injuries may not be initially obvious in children who present with periarticular trauma, and a high index of suspicion is important for diagnosis. Differential diagnosis for a Salter-Harris fracture includes a ligamentous sprain, acute osteomyelitis, or an extraphyseal fracture such as a Torus fracture. Salter-Harris I & Salter-Harris II growth plate fractures commonly are commonly managed by closed manipulation, reduction & immobilization. These are relatively stable injuries and can be retained by adequate plaster. Salter-Harris III & Salter-Harris IV fractures require anatomical reduction with the maintenance of congruity of joint. Physeal fractures can have many complications such as malunion, bar formation, acceleration of growth of physis, posttraumatic arthritis, ligament laxity and shortening of the bone. The key to well-healing fractures is successful anatomic reduction and patients must have regular follow-up for these injuries.